Kevin Love of NBA team Cleveland Cavaliers has opened up about the pressures of playing sport at the top level, which led him to have panic attacks on court.
Photograph: Maddie Meyer/Getty Images

On Friday night the NBA’s commissioner, Adam Silver, made a statement that was both shocking and profound: many of the league’s players, who have an average salary of $7m a year, were “truly unhappy”. He told the MIT Sloan Sports Analytics Conference: “The outside world sees the fame, the money, all the trappings that go with it, and they say: ‘How is it possible they even can be complaining?’ But a lot of these young men are genuinely unhappy.”

As he warmed to the theme of his players’ mental health, Silver told his audience that the NBA All-Star Isaiah Thomas once told him that “championships are won on the bus” with the players having greater camaraderie – and fewer headphones – but times have changed. Indeed one superstar had recently told Silver that from getting off a plane to a game to showing up in the arena he sometimes did not see a single person.

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“He said: ‘I am going to get to my room, stay in my room, get room service and go to the game Sunday,’” Silver said. “He knew if he said it publicly people would say ‘poor baby’. There was a deep sadness around him.”

Such mental health issues, he made clear, had got to a “point where it’s almost pathology”. As Silver explained: “Some players have come from very difficult circumstances; that doesn’t help. Some of them are amazingly isolated.”

Silver’s willingness to address the subject was welcome given how mental health issues remain largely taboo in elite sport. No Alpha Dog wants to be seen as being soft, weak or a little barking. But there is increasing evidence that it is a bigger problem than might have been thought.

The research, published in 2013, also found that the incidence of depression doubled among the elite top 25% of athletes. The authors noted: “The findings suggest that the prevalence of depression among elite athletes is higher than what has been previously reported in the literature.”

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Subsequent studies among Australian and French elite athletes have also shown that the prevalence of common mental disorders (CMDs) – such as stress, anxiety and depression– ranged from 17% to 45% of the athletes studied.

Football is no different. A 2017 study of CMDs among 384 European professional football players found that 37% had symptoms of anxiety or depression at some point over a 12-month period. According to the researchers, a professional football team typically drawn from a squad of 25 players can “expect symptoms of CMD to occur among at least three players in one season”.

Tellingly the authors of another study – among footballers in five European leagues – suggested that mental health issues might be higher compared with the rest of the population but pointedly added: “We would like to emphasise how difficult it is to gather scientific information about mental health in professional football, since such a topic remains a kind of taboo.”

Of course elite sport is brutal. Failure is common, career development uncertain. And injuries, overtraining and concussions can also affect mental health. But speaking on Friday, Silver also suggested that an additional factor these days is social media.

It is hard to argue with that. A couple of decades ago sports stars could make mistakes that were the equivalent of bears defecating in the woods, given that no one heard about them. Now the scrutiny and attention is unrelenting, especially when every phone doubles as a video camera and every fan has a hotline into players’ brains via Twitter. It is hard to ignore a bad game or poorly worded comment when it is met with a 24-hour barrage of bile on social media.

So what should be done? Scientists writing recently in the International Society of Sport Psychology journal stressed that the need for athlete and coach education was paramount in removing stigmatisation around the issue and “to expeditiously help when mild subclinical issues are experienced before these issues become mental illness”.

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But, as they pointed out, a major problem is that “athletes’ self‑perceptions as superior can serve as an internal barrier to seeking mental health treatment, especially in elite sport”.

Maybe times are changing. Last year the National Basketball Players Association launched a mental health and wellness programme – with experts available to allow players to talk about their issues without alerting their teams, who might possibly take a dim view of their problems.

Some have gone public with their issues, including the Cleveland Cavaliers forward Kevin Love, who spoke about a panic attack he experienced on court. As he put it: “Growing up, you figure out really quickly how a boy is supposed to act. You learn what it takes to ‘be a man’. It’s like a playbook: Be strong. Don’t talk about your feelings. Get through it on your own. So for 29 years, I thought about mental health as someone else’s problem.

“I know you don’t just get rid of problems by talking about them but I’ve learned that maybe you can better understand them and make them more manageable.”

It surely helps, too, that Silver is on the front foot and in his players’ corner, driving the debate on such an important issue.

Other leaders – including in British sport – would be wise to follow his lead.